Provider Demographics
NPI:1871519462
Name:ALVIN I. EDELMAN, D.D.S., P.C.
Entity type:Organization
Organization Name:ALVIN I. EDELMAN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-589-3131
Mailing Address - Street 1:910 THIERIOT AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3203
Mailing Address - Country:US
Mailing Address - Phone:718-589-3131
Mailing Address - Fax:718-589-3132
Practice Address - Street 1:910 THIERIOT AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3203
Practice Address - Country:US
Practice Address - Phone:718-589-3131
Practice Address - Fax:718-589-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877054Medicaid